Organization
MCLEOD PHYSICIAN ASSOCIATES II
Active
Parent organization
MCLEOD HEALTH
Other names
McLeod Family Medicine Kingstree
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCLEOD HEALTH
Authorized official
SAMUEL FULTON ERVIN III (SR VICE PRESIDENT AND CFO)
(843) 777-2910
Entity
Organization
Contact information
Practice address
512 NELSON BLVD STE 200, KINGSTREE, SC 29556-4027
(843) 355-5459
(843) 355-9704
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 777-7162
(843) 777-7102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
SC
261QR1300X
Rural Health Clinic/Center
Primary
11529
SC
363AM0700X
Medical Physician Assistant
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHC047
—
SC
Enumeration date
01/26/2007
Last updated
08/08/2019
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